| NPI | 1679341911 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AR 4713) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: AR 4713) |
| Enumeration Date | 2023-12-15 |
| Last Update Date | 2023-12-15 |